# INDIANA SPINE AND PAIN CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Indiana Laser Spine Center Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265644397
- **Authorized official:** DR. PHILLIP R. KINGMA M.D. (OWNER/PHYSICIAN)
- **Authorized official phone:** (317) 577-1800

## Contact information

- **Practice address:** 8202 CLEARVISTA PARKWAY, SUITE 9 E, INDIANAPOLIS, IN 46256-1457
- **Practice address phone:** (317) 577-1800
- **Practice address fax:** (317) 577-1805
- **Mailing address:** 8202 CLEARVISTA PARKWAY, SUITE 9 E, INDIANAPOLIS, IN 46256-1457
- **Mailing address phone:** (317) 577-1800
- **Mailing address fax:** (317) 577-1805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 01040487 | IN | — |
| 261QM2500X | Medical Specialty Clinic/Center | 01040487A | IN | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 02/08/2013